Provider Demographics
NPI:1275779951
Name:STEPHEN L BAUGH OD
Entity Type:Organization
Organization Name:STEPHEN L BAUGH OD
Other - Org Name:STEPHEN L BAUGH OD
Other - Org Type:Other Name
Authorized Official - Title/Position:OPTOMETRIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:L
Authorized Official - Last Name:BAUGH
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:501-676-6844
Mailing Address - Street 1:114 E FRONT ST
Mailing Address - Street 2:
Mailing Address - City:LONOKE
Mailing Address - State:AR
Mailing Address - Zip Code:72086-3235
Mailing Address - Country:US
Mailing Address - Phone:501-676-6844
Mailing Address - Fax:501-676-3910
Practice Address - Street 1:114 E FRONT ST
Practice Address - Street 2:
Practice Address - City:LONOKE
Practice Address - State:AR
Practice Address - Zip Code:72086-3235
Practice Address - Country:US
Practice Address - Phone:501-676-6844
Practice Address - Fax:501-676-3910
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-30
Last Update Date:2008-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARAR2420332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR0709460001Medicare NSC